Field Notes continued
perfecting the electrolyte concentration,
and documenting the effects on
hypertrophied (thickened) heart muscle.
The environment was the UCSF
Cardiovascular Research Institute, where I
was routinely exposed to some of the
greatest research minds of the day.
Cardioplegia was studied around the
world, with exciting reports that perfected
this application. It is used every day
now, in every cardiac surgery operating
room, and is responsible for the excellent
outcomes that cardiac surgeons are
achieving nowadays.
During the time of my residency at
UCSF (1973–1981), significant advances
were being achieved in two major medical
centers specializing in congenital heart
disease that would revolutionize the way
physicians thought about applying
corrective procedures to very young
patients (newborns). The idea was to
correct the congenital heart defects early in
life so that the unwanted consequences
of a persistent perturbed circulation
would not negatively affect the child over
the long term. Dr. Paul Ebert, a mentor
of mine who was also a good friend,
came to UCSF in 1974 and introduced
early operations for truncus arteriosus,
transposition of the great arteries, and total
anomalous pulmonary venous return,
among many others. This was the golden
age in the history of congenital heart
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THE CATALYST Winter 11 | www.sw.org
surgery, and I was fortunate to be trained
in this environment. Dr. Aldo Castaneda
was doing the same thing at Children’s
Hospital Boston.
Out of this philosophy of early repair
came new operations for previously
unrepairable congenital heart disease.
This trend is continuing today with the
advances of neonatal cardiac surgery,
extracorporeal support technology, cardiac
transplantation, fetal interventions, and
much more. The support structure for
congenital heart surgery has blossomed.
The team includes nurse practitioners,
cardiac intensivists, invasive and diagnostic
cardiologists, anesthesiologists, and support
staff, a structure that has resulted in
improved outcomes. Through the Society
of Thoracic Surgeons’ congenital heart
surgery database, specific program
outcomes can be compared with the
national average, thereby allowing selfassessment paradigms to be developed. This
has the effect of improved systems,
development and concentration of
resources where they will do the most good.
An exciting future awaits
The future is bright for congenital heart
surgery. Sustained efforts are now being
made to preserve long-term cognitive
abilities through various applications of
cardiopulmonary bypass and measures to
protect the brain. Stem cell research may
pave the way for heart tissue regeneration,
valve development, and pacemaker
improvements. There may come a time
when the mysteries of immuno-tolerance
for cardiac transplantation will be
unraveled, thereby making obsolete the
toxic medications currently used to
prevent rejection.
This is just a snapshot of some of the
highlights in the development of congenital
heart surgery as seen by someone who has
lived through and participated in the
developmental stages of unparalleled global
achievement. The times are exciting, even
today, and the possibilities are endless. ■
DR. MAVROUDIS is an internationally
recognized leader in pediatric and
congenital heart surgery.
• He is editor of the standard
textbook Pediatric Cardiac Surgery,
now in its fourth edition.
• He has published more than
300 peer-reviewed articles
and book chapters.
• He is past president of the
Southern Thoracic Surgical
Association and the Congenital
Heart Surgeons’ Society.
He is also an avid athlete who races
in five triathlons per year and enjoys
the camaraderie of training with
co-workers.